[larksimian]

I think private options just cannibalize and parasitize public health services. I see it where I live in the UK and where I'm from in Romania.

In Romania it's just outright graft: public hospital doctors direct patients for cheap procedures to their private clinics and toss anything expensive back into the public system. The government pays for all treatments anyway, but public hospital budgets end up being harmed since 'profitable' treatments are being siphoned to the public sector(and doctors outright steal stuff from the public hospital).

In the UK it's a similar selection bias in what's treated privately leading to adverse selection effects for the public sector. Combined with consultant-cancer draining tons of money in order to figure out how to save money(hint: the money-saving solution is never firing the consultants). Society is getting older faster and the government is trying to cut costs on one of the cheapest healthcare systems in the OECD. Basically sabotage from the top down.

Similar effect happens with charter schools in the US, almost impossible to prevent adverse selection effects leading to increased problem-student concentration in the public schools.